Conflict-related excess mortality and disability in Northwest Syria

INTRODUCTION: The Syrian conflict that started in 2011 has been ongoing for over a decade without an end in sight. Estimates regarding excess mortality and conflict-related disability vary widely, and little field research has been done to address this topic. METHODS: A population-based field survey was conducted from 10 to 18 November 2020 in Northwest Syria. Forty-nine clusters were selected using staged sampling based on predefined population distribution maps. Data were collected for the period from 2000 to 2020 and were divided into pre-conflict (2000–2010) and conflict (2011–2020) periods. Mortality rates were compared using the Mann-Whitney U test, and p<0.05 was considered statistically significant. RESULTS: A total of 1483 households were surveyed, for a population of 12 268 people. The crude mortality rate increased 3.55 times between the two periods (p>0.001). In total, 54.3% of war-related deaths were caused by aerial attacks. Despite the continued increase in mortality rates during the conflict period, most deaths from 2017 onwards were related to non-violent causes. Overall, directly and indirectly, the conflict seems to have caused approximately 874 000 excess deaths. A total of 14.9% of households reported having at least one substantial violence-related disability since 2011. CONCLUSION: The conflict caused the tripling of mortality rates in Syria. The estimated excess mortality in our study is higher than previous estimates. From 2017 onwards, most conflict-related deaths were due to non-violent causes. There is a high prevalence of violence-related disabilities in the studied communities. Our data could prove useful for health policymakers.